| NPI | 1780075424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A174059) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A174059) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2025-07-17 |